MEDICARE: MRS. RHONDA K CLARK NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	0024166037	VA

General Provider Information

NPI Number	:	1154379451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RHONDA K CLARK NP

Provider Business Mailing Address
First Line	:	324 T B STANLEY HWY
Second Line	:
City	:	BASSETT
State	:	VA
Zip	:	24055-6108
Country	:	US
Telephone Number	:	276-629-1076
Fax Number	:	276-629-2695

Provider Business Practice Location Address
First Line	:	324 T B STANLEY HWY
Second Line	:
City	:	BASSETT
State	:	VA
Zip	:	24055-6108
Country	:	US
Telephone Number	:	276-629-1076
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	07/09/2008

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